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The Cost of Cutting

Dr. Paul Ruggieri’s latest book provides an insider’s perspective on the economic influence of busy operating rooms & what patients and policymakers can do to improve quality and reduce costs.

Why is surgery so expensive? Why does the cost of surgery incoherently vary from hospital to hospital? Because hospitals and surgeons, in addition to quality care, expect something else: profits. In his groundbreaking new book, “The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry,” September 2 from Berkley Books, Dr. Paul A. Ruggieri takes readers behind the operating room doors, exposing the business influences on the surgical decision process – and what patients and policymakers must do to improve transparency.

“Patients need to be better educated about their options,” says Dr. Ruggieri, a practicing surgeon who specializes in general, advanced minimally invasive and thyroid surgery. “But even when patients do their best to educate themselves, that doesn’t fix the problems inherent in the system itself. Doctors are facing pressure to produce more revenue, hospitals are literally buying referrals, and in the end patients end up paying the price from limitations on choice and potentially diminished quality outcomes.”

In “The Cost of Cutting,” Dr. Ruggieri argues that it’s time to rethink the way surgeons and other medical providers are reimbursed. Surgery, the main source of revenue for U.S. hospitals, is big business. Current fee-for-service payment models create a blind work incentive for hospitals and surgeons resulting in a focus on quantity, not necessarily quality surgical care.

Across the board, reimbursements are declining, hospitals are being penalized, and costs are rising, especially following the enactment of the Affordable Care Act. For surgeons and hospitals alike, these factors put them under constant pressure to generate income and keep operating rooms busy. As a result, unnecessary surgeries are estimated to cost the U.S. health-care system over $150 billion per year.

In his 2012 landmark release “Confessions of a Surgeon: The Good, the Bad, and the Complicated… Life behind the O.R. Doors,” Dr. Ruggieri revealed what life is really like for America’s surgeons. In “The Cost of Cutting,” he exposes the main drivers behind rising medical costs, the acceleration in hospital purchasing of physician practices, and the pressure to keep the operating room doors open.

Filled with personal stories and keen insights from Dr. Ruggieri’s 20-year career in medicine, “The Cost of Cutting” takes an unflinching look at tough truths and offers practical insights about reducing the cost of surgery, restructuring the way we pay for health care, and improving health outcomes for all patients. Dr. Ruggieri advocates for a transparent system that pays based on quality outcomes. Surgeons and hospitals should be paid less for surgeries that lack medical data to support their common use, and data about patient outcomes should be made public. Both should be held accountable for the quality of surgical are they provide.

“The Cost of Cutting” is a compelling and often troubling account of real patients, real doctors, and how money influences medical decisions behind the scenes. With up-to-date research and stories from his practice, Dr. Ruggieri shows how business arrangements among hospitals, insurance companies, medical device companies, and surgeons affect patient choice, the cost of patient care, and potentially the quality of care. He explains how patients can safeguard their own health, and how transparency can make surgery more affordable for all without sacrificing quality.

About “The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry”

Pressured by Business Factors

A surgeon’s recommendation to take a person to the operating room should be solely influenced by medical facts, sound judgment, and experience. There are, however, particularly today, other influences tipping surgical decisions. Nowadays, surgeons are more pressured by “business” factors than ever before—they feel compelled to keep hospital operating rooms busy, to keep their practices going, and to maintain a living.